Form Ds 621 PDF Details

Form DS 621, also known as the "Statement of Financial Interests," is a form that all federal employees and officers must complete on an annual basis. The form requires individuals to disclose any financial interests they have that could potentially conflict with their government duties. Completing Form DS 621 is important for ensuring transparency and preventing conflicts of interest.

This quick guide can help you determine how long it'll require you to fill out form ds 621, how many pages it has, and a few other unique details about the file.

QuestionAnswer
Form NameForm Ds 621
Form Length3 pages
Fillable?Yes
Fillable fields89
Avg. time to fill out18 min 37 sec
Other namestaxable, Revocation, affirm, ROTH

Form Preview Example

IRA DISTRIBUTION FORM

Please complete all pertinent informationrequested below:

 

BRANCH NUMBER/DEPARTMENT

 

 

 

 

PLAN #

 

 

1. PLAN TYPE:

TRADITIONAL

ROTH

SEP

SIMPLE

2.RETIREMENT PLAN OWNER INFORMATION:

Name:

 

Date of Birth:

 

/

/

SSN:

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

Phone:

 

 

 

 

(Primary)

 

 

 

 

(Secondary)

3. REASON FOR DISTRIBUTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regular Distribution (after age 59 ½)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mandatory Distribution (“RMD”) (after age 72 starting 01/01/2020)

Premature Distribution (before age 59 ½):

 

 

 

 

possible IRS penalty

 

exempt from IRS penalty

 

disability

Internal Transfer

 

 

 

 

 

 

 

 

 

 

 

Excess Contribution

 

current year

 

prior year

 

 

 

 

Other:

 

 

 

 

 

 

(e.g., Conversion to Roth Revocation, Recharacterization, etc.)

Death (complete Section 4: additional documentation required.)

4.DISTRIBUTION DUE TO DEATH

Receipt* of funds:

 

Designated IRA beneficiary

Legal representative

*Verification of identify is required

Name:

 

 

 

 

 

 

Date of Birth:

 

 

/

/

 

 

SSN:

-

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

Phone:

 

 

 

 

 

 

 

(H)

 

 

 

(W) or (C)

5. DISTRIBUTION INSTRUCTIONS:

Required Minimum Distribution (RMD)*

 

 

 

 

 

 

 

 

 

 

 

Close Account (s)

 

 

Pay in installations based on Uniform Lifetime Table

 

 

 

 

 

 

 

Specified Amount(s)

 

 

Pay in installments based on Joint Life and Last Survivor Expectancy Table

 

Other

 

 

 

 

 

Pay in installments based on Single Life Expectancy for deaths on or prior to

 

Interest only – Installment Payments

to 12/31/2019 and for certain other beneficiaries (including to Estates,

 

 

 

 

 

 

 

 

Organizations, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Monthly

Quarterly

*RMDs are not required for ROTH IRAs during the participant’s lifetime

 

 

 

 

 

 

 

 

Pay in installments based on a Ten-Year Payout for deaths on or after 01/01/2020

 

 

 

 

 

 

 

 

Pay in installments a flat amount of $

 

 

 

 

(greater than RMD)

 

 

 

 

 

 

 

 

Pay in installments over a Five-Year Payout if deceased under 72 at the time of

 

 

 

 

 

 

 

 

death (for non-entities – Estate, Organization, Charity, Certain Trusts)

FREQUENCY:

Immediately

At Maturity INSTALLMENTS: Monthly

Quarterly

Semi-Annually

 

Annually

Please indicate the month in which distributions should start

Deferred Distribution: If you reach age 72 this year, you may elect to defer this year’s distribution up to April 1st of the following tax year. You are allowed to defer this distribution only for the year that you reach age 72. If you defer your distribution until next year, two withdrawals will be made in the same year. Please indicate which month you would like your deferreddistribution:

January February March

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Federal Income Tax Withholding Election: You must select one, withholding options as noted below. If you do not we are required to automatically withhold from your taxable payments as required by Federal Law.

 

Do not withhold federal income tax from payments

I elect to have the amount of $

 

withheld from my distribution

 

 

 

 

payment(s) (not available for automatic distribution)

 

Withhold federal income tax from payments (10% - normal)

 

other percentage

%

 

Method of Payment

 

 

 

 

 

 

 

 

 

Automated Clearing House (“ACH”) Entry

 

 

 

 

 

 

 

 

 

Check mailed to the recipient’s address

 

Check mailed to recipient of funds in Section 4

 

EFT deposit to IRA owner’s Apple Bank Account:

 

 

 

 

 

 

 

 

 

Savings: Checking: NOW: or Money Market Account No.

 

 

 

 

 

 

 

 

 

Specify Dollar ($) Amount(s):

Specify affected retirement account(s): list numbers below

#

 

 

 

$

 

 

 

 

 

 

 

#

 

 

 

$

 

 

 

 

 

 

 

#

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please note that early withdrawals from time deposit accounts may result in interest penalties. See your accountdisclosures.

IF YOU HAVE SELECTED ACH ENTRY as your method of paymenti:

(A)Your Financial Institution must be an ACH Participant (acting as the RDFI); and

(B)A VOIDED check or pre-printed deposit ticket marked VOID must be attached with this authorization form.

Additionally, please provide the following Third Party Financial Institution information:

FINANCIAL INSTITUTION NAME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(“RDFI”) Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Routing Transit/ABA Number:

 

 

 

 

 

 

 

 

 

Account Number:

 

-

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Checking Account

Savings Account

6.AUTHORIZATION

By signing this authorization, below:

You authorize us, as Trustee, to make a withdrawal(s) from the IRA account(s) identified above in the manner and for the reason(s) indicated. You affirm that the withdrawal(s) are permitted under the terms and conditions of the applicable Traditional, Roth, SEP or SIMPLE IRA Adoption Agreements that you have signed and meet all legal requirements of the Internal Revenue Code (“IRC”). Apple Bank may rely on your statements herein and shall not be held liable for any tax, penalty or other consequence incurred in connection with any withdrawal hereby authorized.

You represent and warrant that the referenced Third Party Financial Institution (“Third Party FI”) account(s) to which you have directed your distribution(s) is/are held in your name.

You acknowledge that withdrawals from a non-Roth IRA will be taxed as ordinary income and may be subject to a 10% early withdrawal penalty if taken before age59½.

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You recognize that withdrawals made from any SIMPLE IRA prior to age 59½ and within the first two years of participating in an employer’s SIMPLE IRA plan may be subject to a 25% early withdrawal penalty.

You shall Indemnify Apple Bank from any liability in the event that you fail to meet any applicable IRS requirements.

You certify under penalties of perjury that you are a U.S. citizen or other U.S. person (including a resident alien individual) and that the tax identification number shown (TIN) on this form is your correct TIN.

Customers selecting ACH Entries:

Authorize and request Apple Bank to make direct transfer EFT distributions from the Apple Bank IRA listed in this form by initiating debit entries to such Apple BankIRA.

Authorize us, upon receiving instructions from you or as otherwise authorized by you, to make payments from you and to you, by credit entries to the designated account at the Third Party Financial Institution identified above (the “Third Party FI”). You authorize the Third Party FI to process such entries and to credit the designated account(s) for such entries. You ratify such instructions and agree that neither we nor any mutual fund will be liable for any loss, liability, cost, or expense for acting upon all such instructions believed to be genuine if we employ reasonable procedures to prevent unauthorized transactions. You agree that this authorization may only be revoked by written notice to us in such time and manner as to afford us and the Bank a reasonable opportunity to act uponit.

Warrant and represent that (i) the third party’s account identified in Section 3 is owned by a natural person, (ii) that person has authorized his/her account to be credited in accordance with your instructions, and (iii) the account has been established for personal, family, or household use, and not for commercial purposes.

Name of individual receiving funds (please print)

Signature

Date

7.Approved by APPLE BANK FOR SAVINGS

Authorized Signature

 

Date

 

 

 

 

Print Name

Teller Number

iIf your ACH or EFT deposit cannot be originated or processed for any reason a check will be mailed to the record address until such time a new designation is presented.

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How to Edit Form Ds 621 Online for Free

It is really an easy task to fill out the apple bank online distribution form empty lines. Our PDF editor will make it virtually effortless to fill in any sort of PDF. Below are the primary four steps you need to take:

Step 1: Pick the button "Get Form Here".

Step 2: At this point, you are able to update the apple bank online distribution form. This multifunctional toolbar lets you add, erase, change, highlight, and conduct other sorts of commands to the content and areas within the file.

Enter the requested information in every area to fill in the PDF apple bank online distribution form

example of blanks in affirm

Indicate the information in REASON, FOR, DISTRIBUTION DISTRIBUTION, DUE, TO, DEATH Receipt, of, funds Designated, IRA, beneficiary Legal, representative Verification, of, identify, is, required DateofBirth, Phone, S, SN Wor, C Name, Address, FREQUENCY, DISTRIBUTION, INSTRUCTIONS and Required, Minimum, Distribution, RM, D

Entering details in affirm stage 2

Indicate the main details in January, February, and March field.

Filling in affirm part 3

The Specify, Dollar, Amounts other, percentage and FINANCIAL, INSTITUTION, NAME section will be applied to put down the rights or responsibilities of both parties.

affirm SpecifyDollarAmounts, otherpercentage, and FINANCIALINSTITUTIONNAME fields to insert

Finalize by looking at all of these sections and completing the suitable data: FINANCIAL, INSTITUTION, NAME RDF, I, Address Routing, Transit, ABA, Number AUTHORIZATION, By, signing, this, authorization, below Account, Number, Type, of, Account Checking, Account and Savings, Account

part 5 to finishing affirm

Step 3: Hit the "Done" button. Now you may export the PDF file to your device. Besides, it is possible to forward it via email.

Step 4: Generate copies of your document - it will help you prevent possible concerns. And fear not - we are not meant to share or look at your details.

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